The Research On The Relationship Between The Common Syndromes Of Lung Inflation And AQP-1 And PCT

Objective: From the point of view of the combined modern medicine and traditional Chinese medicine(TCM), the project observed three common syndromes of lung inflation(edema syndrome due to yang deficiency, lung phlegm heat syndrome, and qi insufficiency of lung and kidney) in clinic. Serum AQP-1 and PCT were taken as the main indicators, in addition to other assistant methods including TCM four diagnostic methods, routine blood test, blood gas analysis, pulmonary function examination, and cardiac color ultrasound examination. The study explored relevance of the three common syndromes of lung inflation to serum AQP-1 and PCT, and reveal the intrinsic correlation factors of the lung distension syndrome type, which plays an important role in investigation of pathological mechanisms and targeted therapy of these syndromes.Methods: Using clinical epidemiological methods and randomized, parallel controlled trial design, a total of 107 cases, including 37 cases of edema syndrome due to yang deficiency, 36 cases of lung phlegm heat syndrome and 34 cases of qi insufficiency of lung and kidney, were included according to the inclusion criteria.The patients were scored according to their clinical manifestations of admission, main symptoms and signs. Blood samples were collected on the day of admission for laboratory tests, namely, routine blood test, blood gas analysis and B-type natriuretic peptide(BNP), followed by cardiac color Doppler ultrasonography(left and right left atrial diameter, left and right ventricular end diastolic diameter, left ventricular ejection fraction, pulmonary artery pressure, etc.) and pulmonary function test(FEV1/FVC and FEV1/predicted value). The serum AQP-1 and PCT were determined by using double-antibody sandwich assay. Using the detailed observation record and clinical data, the effects of serum AQP-1, PCT, scores of main symptoms and signs as well as other laboratory indicators on lung inflation were evaluated by analyzing the variations of the scores of main symptoms and signs, and results of related laboratory indicators, lung function and cardiac ultrasonography between the three common syndromes.Results:(1) General information: There was no significant difference in age, disease course, gender ratio among the three groups(P>0.05).(2) Serum AQP-1 levels comparison: AQP-1 level was the highest in water diffusion due to Yang insufficiency group followed by lung and kidney qi deficiency group and phlegm heat obstruction in lung group showing significant difference between the water diffusion due to Yang insufficiency group and phlegm heat obstruction in lung group(P<0.01). Significant difference in serum AQP-1 level was also found between the water diffusion due to Yang insufficiency group lung and kidney qi deficiency group(P<0.05), but comparison between phlegm heat obstruction in lung group and lung and kidney qi deficiency group showed no significance(P>0.05).(3) Comparison of serum PCT level: Serum PCT level was the highest in phlegm heat obstruction in lung group followed by water diffusion due to Yang insufficiency group, lung and kidney qi deficiency group. Significant differences were found between phlegm heat obstruction in lung group and the other two groups(P<0.05), but no significant difference was found between the latter two groups( P>0.05).(4)In patient with phlegm heat obstruction in lung syndrome, AQP-1 level was positively correlated with PCT levels(P<0.01).(5) the relationship between age, disease course and serum AQP-1 and PCT levels:(1)Age was not correlated with AQP-1 or PCT levels(P>0.05);(2)Disease course was positively correlated with AQP-1 level(P<0.01), but it was not correlated with PCT level(P> 0.05).(6)Correlation between cough, sputum, wheezing score and serum AQP-1,and PCT levels:(1)Cough scores and AQP-1 levels were negatively correlated(P <0.05); While sputum scores and AQP-1 levels were not correlated with each other(P> 0.05). Asthma, edema score and AQP-1 was positively correlated showing statistically significance(P<0.01). Cyanosis and AQP-1 levels were positively correlated too showing significance(P<0.05);(2)Cough, sputum score and PCT levels were positively correlated(P<0.05), but asthma, cyanosis, edema score and PCT levels were not(P> 0.05).(7) Blood count parameters and serum AQP-1,PCT levels: white blood cell count, neutrophil percentage and AQP-1, PCT levels were not correlated with each other(P> 0.05).(8) Blood gas analysis related indexes and serum AQP-1 and PCT levels:(1)PO2 level and AQP-1 levels were negatively correlated(P<0.05) but PCO2 level and AQP-1 levels were not correlated with each other(P> 0.05);(2)PO2, PCO2 levels and PCT levels were not correlated with each other(P>0.05).(9) Correlation between BNP and serum AQP-1, PCT levels: BNP level was positively correlated with AQP-1 level but had not correlation with PCT levels(P>0.05).(10) Relationship between FEV1/predicted value% and serum AQP-1and PCT levels: FEV1 / predicted value% was correlated with neither AQP-1 nor PCT levels(P>0.05).(11) Relationship between chocardiographic related indexes and serum AQP-1 and PCT levels:(1)Left and right atrial, right ventricular end-diastolic diameter, mean pulmonary arterial pressure were positively correlated with AQP-1levels(P<0.01); while left ventricular ejection fraction and serum AQP-1 levels were negatively correlated with each other(P<0.05). On the other hand, left ventricular end-diastolic diameter was not correlated with AQP-1 level(P>0.05);(2)PCT level was not correlated with indexes including cardiac chamber diameter, left ventricular ejection fraction, mean pulmonary artery pressure(P>0.05).Conclusion:(1)AQP-1, PCT may be the Identification basis of yang insufficiency and phlegm obstruct the lung and other common syndromes.AQP-1 is a characteristic index of edema syndrome due to Yang deficiency; PCT is the characteristic index of phlegm heat obstructing the lung.(2)Serum AQP-1 and PCT levels increased when phlegm obstruct the lung with infection become more serious.(3)Serum AQP-1 level increased by the extension of the course,suggests that the longer the course of disease has the tendency of the development of the syndrome of Yang deficiency.(4)Cough and sputum symptoms became serious after inflammatory mediators levels changed which were indirectly affected by AQP-1 level decreased & PCT levels increased; The increased AQP-1 may indicate asthma, cyanosis and edema severity.(5)White blood cell count and neutrophil percentage in inflammatory cells did not find correlation with AQP-1 and PCT.(6)Serum AQP-1 expression levels gradually increased when PO2 level decreased,the increased AQP-1 may indicate asthma, cyanosis and edema severity.(7)AQP-1 level will increased when BNP level increased. AQP-1 levels may be contact with the severity of heart failure. Changes of the BNP levels were not associated with serum PCT level.(8)FEV1/predicted value% were not associated with serum AQP-1 and PCT levels.(9)With the enlargement of the left and right ventricular end diastolic diameter, the mean pulmonary artery and left ventricular ejection fraction, the AQP-1 level was increased, indicating that AQP-1 may be involved in the development of myocardial injury in heart failure.